Malnutrition in India: Causes and Remedies

The State of India is a paradox. While it is one of the fastest growing economies in the world, it is also home to 57 million of the world’s 146 million malnourished children. This menace continues to remain a silent emergency in the country, with 47 per cent of children under five either underweight, stunted, wasted or with micronutrient malnutrition.
Several nutrition awareness programmes and training courses for improving the dietary habits of people, too, are in place. Under the 30-year-old Integrated Child Development Services (ICDS) Scheme, supplementary nutrition is being provided to children up to six years of age and to pregnant and lactating mothers.
India's Position in Global Hunger Index
The country which figures 94th among 119 countries on the Global Hunger Index also faces the problem of acute malnourishment. However, a government survey has pointed out that malnourishment poses a major threat to India’s socio-economic growth. Indeed, malnutrition not only affects individual growth but also impedes productivity. India loses four per cent of its Gross Domestic Product (GDP) due to malnutrition that stems from a host of factors — poverty, illiteracy, lack of awareness, poor access to health care, unsafe drinking water and poor sanitation.
Malnutrition not only enhances their susceptibility to infection, but it also affects their educational achievements, health and overall productivity when they grow up. Consequently, child malnutrition is not only responsible for 22 per cent of the country’s disease burden and half of the 2.3 million child deaths annually, but it also costs India at least $ 10 billion per year in terms of lost productivity, illness and death. Such a colossal loss is unacceptable for a growing global power like India.
The tragedy of persistent child malnutrition in the country, despite steady economic growth, reflects not only the inequitable character of this growth but also the failure of health and nutrition delivery mechanisms, to the poor. It also indicates a lack of political will to deal with the crisis on a priority basis. In fact, child malnutrition in India is among the highest in the world, along with Bangladesh, Ethiopia and Nepal.
National Family Health Survey Report
Recently, the third National Family Health Survey report was released which tells a grim state of child malnutrition in the country. About 45.9 per cent children under three are underweight, 38.4 per cent are stunted and 19.1 per cent wasted. China, the world’s most populous country, has less than 10 per cent of its child population underweight. More humiliating is the discovery that even sub-Saharan Africa has almost half our percentage of underweight children.
Scepticism in accepting the disturbing statistics on malnutrition in India is because we have been made complacent by the plentiful food stocks and over-loaded Food Corporation of India (FCI) godowns. We pride our Midday Meal Scheme for school children which is the largest nutritional programme in the world.
The ICDS is another flagship project. It has now about six lakh centres with some seven lakh anganwadi workers and an equal number of helpers catering to over four crore pre-school children as well as pregnant and lactating mothers. But despite all these things, malnutrition rates in India over the last 10 years have declined at the very modest pace of a mere two per cent per annum, lower than many countries with a comparable socio-eco nomic profile. Bangladesh has brought down its malnutrition rates by about six per cent a year.
Severe malnutrition is more frequent among girls (19.1 per cent) than boys (16.9 per cent). While most infants in India are initially breastfed, only 37 per cent children are exclusively breastfed for four months. Malnutrition rates among children of 0-3 years vary greatly across States, from Madhya Pradesh (55.1 per cent), Bihar (54.4 per cent), Orissa (84.4 per cent), Uttar Pradesh (51.7 per cent) and Rajasthan (50.6 per cent) to Goa (28.6 per cent), Manipur (27.5 per cent) and Kerala (26.9 per cent).
Malnutrition continues to be equated with food shortage and the solution canvassed is to simply increase caloric intake, not realising that the Khichdi-dalia staple provided at such meals is inadequate. Children require special food in small quantities which is dense in energy and nutrients, and not adult food, since children consume much smaller quantities. This explains why 75 per cent of Indian children under three suffer from iron deficiency (anaemia), fifty per cent from Vitamin A deficiency, apart from very high rates of zinc and folate deficiency.

Important Causes
Malnutrition in children is an outcome of insufficient food intake, impaired utilisation or depletion of nutrients due to repeated infectious diseases and parasites and Low Birth Weight (LBW). While poverty and food insecurity contribute to malnutrition in India, some important causes, most of which are preventable, include improper and unsafe infant feeding and child care practices, gender disparity in distribution of food and general neglect of the girl child, as a result of which 60 per cent of Indian women in the reproductive age group are anaemic, a major contributing factor for LBW.
Undoubtedly breastfeeding is an effective way of ensuring healthy growth and development of infants and protecting them against infections. However, only 37.1 per cent newborns are breastfed within a day of birth in India. Colostrum (first milk), which is essential for the infant’s nutritive and immunologic value, is often discarded as old and impure milk. Instead babies are fed with pre-lacteals like tea, ghuttis, diluted milk in many rural and poor urban households. Many families either do not initiate complementary food when the baby reaches the age of six months or give foods with sub-optimal nutritive value. Often, owing to the caregiver’s lack of knowledge, such food may be unhygienic and may introduce infection resulting in diarrhoea. The vicious cycle of malnutrition and infection thus begins.
As per the recent report of the World Food Programme (WFP), about 18,000 children die of hunger and malnutrition every day, he fact which uderscores the urgent need for the Government to respond to poverty in all its mani­festations.
Mid-Day Meal Scheme
Mid-Day Meal Scheme was fomally launched on Aug. 15, 1995 under the National Programme of Nutritional Support to Primary Education (NP-NSPE). The objective of the scheme is to give a boost to universalisation of primary education by increasing enrolment, attendance and retention of children to primary classes. This ambitious social welfare programme improves the nutritional status of children of primary classes studying in schools run and aided by the Government.
Under the scheme, Central assistance is provided to States for the following :
(i) Hundred grams of foodgrains per child per school day where there is a meal programme. Alternatively, three kg per child per month for 10 months.
(ii) Admissible transport subsidy for transportation of foodgrains from the nearest FCI depot to the school, subject to a ceiling of Rs. 50 per quintal. The cost of converting foodgrains into cooked meals is borne by the State Governments or local bodies.

The Remedies
There is a school of thought, though, which believes it would be far more efficacious at this point to specifically target areas which account for the maximum levels of malnutrition rather than expanding haphazardly. Some 10 per cent of Indian villages account for 28 per cent of child nutrition.
Eradication of malnutrition also makes sound economic sense. In countries with widespread deficiencies of the three major nutrients, it is estimated that micronutrient malnutrition results in a loss of about five per cent of the GDP whereas solving the problem would cost less than 0.3 per cent of the GDP.
Thus, it is important for the Government as well as the Non-Governmental Organi­sations (NGOs) to put greater effort and resources on malnutrition prevention and take early action rather than coping with malnutrition when it has already set in.